Pediatric basic and advanced life support: an update on practice and education

Abstract

This review aims to summarize the major changes in the 2010 Heart and Stroke foundation of Canada (HSFC) and the American Heart Association (AHA) Pediatric Basic and Advanced Life Support Guidelines. The Guidelines were based on the International Liaison Committee on Resuscitation's (ILCOR) comprehensive, evidence-based review of the resuscitation literature. The key recommendations from the Guidelines include: the removal of "look, listen and feel" and a de-emphasis on the use of the pulse check by healthcare providers to diagnose cardiac arrest; a change in the sequence of resuscitation for patients in cardiac arrest from the previously well-known "A-B-C" i.e. Airway, Breathing, and Chest Compressions to "C-A-B" i.e. Chest Compressions first; modification to the appropriate depth of compression (at least 1/3 of the anterior-posterior depth of the chest wall or about 4 cm in infants and 5 cm in children); end-tidal CO(2) monitoring (in intubated patients) to assess the quality of chest compressions and optimize cardiopulmonary resuscitation (CPR); and titrating Fi0O2 once "Return of Spontaneous Circulation" (ROSC) is achieved to maintain an oxygen saturation between 94-99%. Overall, pediatricians, family and community physicians who may care for acutely ill children should be aware of these updated guidelines in order to provide the best possible care to their patients.

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Table 1: Classification of recommendation and level of Evidence